Transcript Document
ICPD Beyond 2014
[Framework of Actions for the follow up to the Programme of Action of the International Conference on Population and Development Beyond 2014 [Operational Review of progress in the Programme of Action from the 1994 International Conference on Population and Development]
Thematic Pillars for Population & Development Post-2014
Cross-Cutting: Equality & Human Rights
Affirmation of the entitlements of all persons to the rights & freedoms set forth in the Universal Declaration of Human Rights, without distinction
of any kind.
Recognition that the relationship of population to development is so intertwined with issues of poverty, patterns of production and consumption, and inequality, that none can be fruitfully addressed in isolation.
Methods & Sources
• • • • 3 thematic meetings: youth, human rights, women’s health Regional UN meetings Review and analysis of national data (DHS, MICS, WHO, UNAIDS, UNICEF, etc.) Global Survey of 174 governments: – Commitments last 5 years – Priorities next 5 years
• • • •
Wealth Education Employment Discrimination
• • • • • • Women Youth Older Persons Disabled Persons Indigenous Persons …. all persons....
Global Wealth Pyramid
(Credit Suisse 2012)
Unequal gains in income, 1988-2008
Impact on development?
Women’s Empowerment & Gender Equality
• • Women’s labour force participation – Gender gap narrowed slightly since 1994 – Women paid less, over-represented in vulnerable, informal employment, – Under-represented positions of power and decision making, and with a disproportionate share unpaid care responsibilities GBV & harmful practices: – 1 in 3 women experience physical/sexual abuse – 1 in 4 men in a 10,000 person multi-country study in Asia & Pacific admitted to perpetrating rape; – Despite growing legislation against harmful practices, early and child marriage and FGM/C remain prevalent Government priorities for gender equality and women’s empowerment: economic empowerment and employment (67%), political empowerment and participation (56%) and the elimination of all forms of violence (53%).
Per cent 100 90 80 30 20 10 0 70 60 50 40
Support for gender equality by region 2004-2009
University education Business executives Political leaders Right to a job Africa Asia Eastern LAC West Europe &
“Men make better political leaders than women” Proportion who disagree - 1995-2005
85%
% of Governments Addressing Equality in Work & Family Life ?
(Global Survey 2012)
64% 90% 54% 41%
Commitments or laws against workplace discrimination of women Policy commitments to work/family balance Maternity leave Paternity leave Breastfeeding in the public workplace
~ All 5 policies & provisions? 18.7%
(26/113)
35% 30% 25% 20% 15% 10% 40%
The rising proportion of older persons (60+ years), 1950-2050
Africa Americas Asia Europe Oceania World 5% 0%
• • •
Older Persons
Proportion of older persons is 11% globally, 20% in Europe, rising in all countries By 2050, 20% of the global population will be over 60 Needed pensions, health care, housing, social protection • • • • Older People & Work More than 40% of 65+ in Africa are economically active, nearly 25% in Asia, Latin America, the Caribbean Women’s labour force participation after age 65 has risen; Global illiteracy rate is 26% among persons aged 65+ (25% in Latin America, 68% in Africa) – higher among women; Lifelong learning, retraining, and flexible employment are critical.
30% 25% 20% 15% 10% 5% 0% 35%
The demographic importance of young people 10-24 yrs, 1950-2050
Africa Americas Asia Europe Oceania World
Adolescents & Youth
• • • • Education Gains in primary, secondary school attainment, primary school enrollment rates approaching 90% Largest gains in primary school completion among girls High variation in access and quality – urban/rural, wealth Secondary education far from universal • • • Employment Of estimated 197 million unemployed, nearly 40% are 15-24 Young people disproportionately in low paid, intermittent, insecure work 600 million productive jobs needed over the next decade
Adolescents & Youth
• • Child/Early marriage Legal age of marriage 18 in 158 countries Yet 34% of women 20-24 in developing regions are married or in union by age 18; 12% by age 15 • • Adolescent Pregnancy Early marriage is very linked to early fertility: 1 in 5 girls in developing countries become pregnant before age 18, and 90% of births under age 18 occur in the context of early marriage Higher levels of education are associated with lower ABR Government priorities for young people: economic empowerment and employment (70 %), social inclusion and education (56 %)
Stark Health & Wealth Inequalities for Indigenous Peoples
• • • Life expectancy of indigenous vs. non-indigenous children: 20 years in Nepal or Australia 13 years in Guatemala 11 years in New Zealand Among 28 million indigenous people in Latin America almost no change in poverty (~80%) from early 1990’s to early 2000’s, and poverty among indigenous… – 8x non-indigenous in Paraguay – 6x … Panama – 3x …Mexico
Unequal Burden of Disability
• • • 5% age 0-14 are live with a disability 15-20% over age 15 live with disability Rising dramatically with age – and increasing due to population aging, rise in years lived with ncd’s • • Women more than men Higher in lower income countries
Non-Discrimination Applies to All Persons
• • • • • • Ethnic and Racial Minorities Persons of Diverse Sexual Orientation and Gender Identity Persons Living with HIV and AIDS Migrants Sex Workers ……….many others
Social Cost of Discrimination
• • • Even without physical violence, stigma and stereotype threat leads to loss of human health & productivity: negative birth outcomes higher depression and anxiety lower performance on aptitude tests & productivity • World Values Survey data highlights national differences in discriminatory attitudes: where greater intolerance, directed towards multiple population groups
Key Messages:
Dignity & Human Rights
1. Wealth and income inequalities are increasing 2. Empowerment of women and gender equality remain unfulfilled 3. Lifelong learning, and building human capabilities, warrants substantial investment – especially for young people 4. Public attitudes towards gender equality and stigma vary greatly between countries – warrant tracking
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Spatial & Social Inequalities
• • • • • • • • Sexual & Reproductive Health Maternal Health – 47% Rising Use of Contraception Changes in Abortion Aggregate gains mask serious inequalities Challenge of STIs Young people?
CSE – gender “skills”
Changes in Global Health 1990-2010
1. Life expectancy increased from 64.8 years in 1990-95 to 70 years by 2010-2015 (5.2 years) 2. Under-5 mortality rate dropped from 90 deaths per 1,000 live births in 1990 to 48 in 2012 3. Dramatic shifts in global health burden towards NCDs and injuries 4. But - persistence of communicable, maternal, nutritional and neonatal disorders in sub-Saharan Africa, South Asia • In 1990 and 2010, SRH-related illness was 14% of global burden of disease – but changing composition.
Skilled Birth Attendance increased ~ 15% worldwide, 1990-2010
(DHS, MICS)
Percentage of women who had a skilled attendant (doctor, nurse or mid-wife) at birth, 1990 and 2010 100
Eastern Asia
80
Latin America/Caribbean Northern Africa Western Asia South Eastern Asia World
60
Southern Asia sub-Saharan Africa
40 20 0
1990 2010
Source: UN Millennium Development Goals 2012 Report Statistical Annex
Good progress: Absolute & Relative Gains in Skilled Attendance
Country example Country example Country example 1990 1995 2000 Country example 2005 2010 1990 1995 2000 2005 2010 1990 1995 2000 2005 2010 Richest 20% Fourth 20% Middle 20% Second 20% Poorest 20% 1990 1995 2000 2005 Source: MDG5b+ Database and additional analysis, UNFPA 2010
Stagnancy / increasing inequalities in Skilled Attendance
Country example Country example Country example 1990 1995 2000 Country example 2005 2010 1990 1995 2000 2005 2010 1990 1995 2000 2005 2010 Richest 20% Fourth 20% Middle 20% Second 20% Poorest 20% Source: MDG5b+ Database and additional analysis, UNFPA 1990 1995 2000 2005 2010
Contraceptive Prevalence Rate (CPR) increased ~ 10% world-wide, 1990-2010
Percentage of married (or in union) women 15 – 49 years who are using modern method of contraceptive, 1994 and 2014 80 60
North America Latin America/Caribbean Asia Europe World Oceania
40
Africa
20 0
1994 2014
Source: UN Department of Economic and Social Affairs, World Contraceptive Use 2012
Good progress: Absolute & Relative Gains in CPR Good progress: Absolute & Relative Gains in CPR
Country example Country example Country example Country example Country example Country example 1990 1990 1995 2000 1995 Country example 2005 2010 1990 2010 1990 1995 1995 2000 2000 2005 2005 2010 1990 2010 1990 1995 1995 2000 2000 2005 2005 2010 2010 Richest 20% Fourth 20% Richest 20% Middle 20% Fourth 20% Second 20% Middle 20% Poorest 20% Second 20% Poorest 20% 1990 1995 2000 2005 2010 1990 1995 2000 2005 2010 Source: MDG5b+ Database and additional analysis, UNFPA
Stagnancy / increasing inequalities in CPR
Country example Country example Country example Country example Country example Country example 1990 1990 1995 2000 2005 1995 2000 Country example 2005 Country example 2010 2010 1990 1990 1995 1995 2000 2000 2005 2005 2010 2010 1990 1990 1995 1995 2000 2000 2005 2005 2010 2010 Richest 20% Fourth 20% Middle 20% Poorest 20% 1990 1990 1995 1995 2000 2000 2005 2005 2010 2010 Source: MDG5b+ Database and additional analysis, UNFPA
Trends in Abortion
• • • • Number of abortions declined from 45.6 million in 1995 to 43.8 million in 2008, of which 22 million are unsafe 8.7 million unsafe abortions among women age 15-24, 3.2 million at 15-19 yrs Global rate of abortion declined from 35 per 1000 women (age 15-44 yrs) in 1995, to 29 in 2008; highest rates in East Europe (43); lowest in West Europe (12) 86% took place in the developing world
Deaths due to Unsafe Abortion
• Risk of death due to abortion is decreasing globally: – better technologies, – more legal access – more use of WHO guidelines for safe abortion and post-abortion care • Yet death rates from unsafe abortion in Africa and Asia remain shockingly high at 460 and 160 deaths per 100,000 unsafe abortions
Sexually Transmitted Infections have risen - weak surveillance
• • • WHO reports 40% rise in STI incidence (trichomoniasis, gonorrhea) over the past 20 years – (esp Latin America, SSA) Monitoring is extremely weak outside the wealthiest countries; Highest rates among the urban young 15-35;
HIV is far from eradicated
• • • • • 33% global decline new HIV infections; Preventive behavior decline; Delayed infection in south Africa; 34% eligible patients get ART; HIV is rising in Eastern Europe, Central Asia; (World Bank 2011)
Persistent Inequalities in access to Quality SRH care
• • • • • Aggregate gains in SRH care not universal SSA and South Asia weakest health systems, wealth/spatial inequalities also high; Most evident for urgent care (SKATT) – than for CPR Health workers, information systems critical PMTCT in 18 countries – only 9% of infants born to HIV+ mothers located at 1 st immuniz.
Professionalization of delivery care, 2000-2015
Poor monitoring of young people’s access to SRH & CSE
• Limited SRH service data available for youth yet….
– Women < 25 yrs account for ~50% of deaths from abortion – Persons 15-24 yrs account for 41% of new HIV infections worldwide • Few CSE evaluations, but best show those addressing gender and power markedly more effective – expansion, standardization, monitoring
Key Messages:
Health
1. There are persistent inequalities in access to fundamental SRH services 2. Health systems need innovative strengthening, linking rural and urban, & assuring continuity of care for SRH 3. Improve access to SRH & CSE for young people, including age 10-14 4. Strengthen STI diagnostics, treatment, surveillance 5. Fully integrate HIV and SRH services 6. Start building systems for reproductive cancers, NCD, elder care
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Spatial & Social Inequalities
• • • • Changing Household Structures Internal Migration & Urbanization International Migration Insecurity of Place
Changes in living arrangements, households
• • • • Single-person households are rising in all regions outside of Africa Persons never married has risen across a majority of countries of Europe, Oceania and the Americas Proportion of persons divorced or separated has increased Single parent households are rising – not in all regions – and these households are primarily headed by women
Proportion of all hh’s that are one person hh’s, 1990-2010
Total Population by City Size, 1970,1990,2011,2025
Key Messages:
Security of Place, Mobility
1. Household structures and living arrangements are increasingly diverse 2. The world must plan and build sustainable cities, and strengthen rural-urban linkages 3. International migrants need greater security, and governments must increase cooperation 4. Those with insecurity of place (Homelessness, Displacement, Statelessness) are poorly counted
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Accountability
• • • • Elaboration of Institutions Participation Knowledge Systems Partnerships, Collaboration & Coherence
Global Survey: % of Governments committed to participation of key groups in decision-making
76% 73% 61% 47%
Adolescents and youth Women Persons with disabilities Older persons
~ All 4 key population groups? 21.7%
(30/138)
Strengthen the Knowledge Sector
• • • • • Knowledge sectors remain weak – often detached from government Monitoring population dynamics is essential to enhance dignity, health and human rights – and promote development Global SRH data have improved, but health data still weak for MDG monitoring – STI’s, morbidity especially Gender statistics increasing; gaps in GBV, values Very weak data on migration, either internal or international – and on those with insecurity of place – e.g. the homeless
Data for Population & Development
• • • • • Only 109 of 193 member states have complete coverage of birth registration; only 99 have complete coverage of death registration. Only about 1/3 of births in LDCs are registered, despite a 30% gain since 2000; difficulty registering births without a male relative Progress: In the 2010 census round 7 Member States had no census plans, compared to 25 in 2000 Census dissemination remains weak - with important implications for public policy, and use of population dynamics in development planning Inadequate number of trained census experts and demographers in developing countries
Collaboration, Partnerships & Resource Flows
• • • • Since 1994: number, diversity of donors increased The architecture for development cooperation shaped by the urgent response to HIV/AIDS Funding for 4 costed ICPD components (FP; RH, STI&HIV/AIDS; and research, data, policy), increased in absolute dollars – with dominant share to HIV/AIDS – HIV/AIDS received 66% of total assistance (2011) – RH received 22% Global targets and accountability matter: focus on MDGs
Key Messages:
Governance & Accountability
1. Participation should be more systematic, more inclusive 2. Population dynamics are critical to development planning 3. Knowledge sectors need strengthening 4. Nature & range of partnerships has increased, need equality and coherence 5. Need for accountability systems
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Dignity, Human Rights, Non-Discrimination for All Lifelong investment in health & education, particularly for young people Universal access to SRHR Security of Place, Safe Mobility Sustainable, inclusive cities linked to rural areas A fundamental change in patterns of consumption Stronger global leadership and accountability